“Once again, thanks for engaging the veterinary industry and client owners with your work and experience. I enjoy your enthusiasm and passion for the area.” DVM, ACVS (American College of Veterinary Surgeons), South Texas
“Thanks so much, Deborah! The book is impressive. Maybe you should leave a copy at (some shelters) since they put so many cruciate dogs on the euthanasia list…Great work and thank you!” DVM, Austin, TX
“Read your book. Excellent job. Now at ACVS they are all for non surgical acl (rehab)…Good job!” DVM, Austin, TX
“Finished reading “instead of surgery” kindle booklet. Bueno! Great discussion on importance of pain control, in particular. ” DVM, Austin, TX
“Hi Deborah! I read your book the night I got it. I really like it and have already recommended it to a client last week. I hope she bought it. I will write a review for amazon for you, too. I hope you are really successful in this. I know how hard you work!” DVM, Kerrville, TX
“Once again, thanks for engaging the veterinary industry and client owners with your work and experience. I enjoy your enthusiasm and passion for the area.” DVM, ACVS, South Texas
“I’ve been a client of Rehab and Conditioning since last November (2014).
My 9/10 year old heeler had/has a knee injury. In lieu of surgery, I decided to seek out a specialist to help and educate me on my dog’s injury and rehab plan.
Deborah is great! She’s smart and knowledgeable. She listens. She helps me to learn more so that I know how to work with my dog and gives me options for his recovery plans/schedules. Specifically, she works with my schedule – both with how to do exercises and also for scheduling meetings to review progress. She is even available for phone and email consults – where I can send her videos of progress and get her feedback.
I would recommend to any owner who is working with an animal who has an injury to seek out Deborah. She’s wonderful and if you follow her advice and her program, I have total confidence in saying that she will be so helpful to you and your pet.
Thank you Deborah. I have so much gratitude for your help, your patience, your knowledge, all of your support during this journey in my boy’s life!”
Renee S. Austin, TX
(Last I checked, 2017, Sputnik continues to do well and runs amok on trails in Colorado–Rehabdeb)
And you will find links to purchase the booklets from most Amazon platforms around the world. I include Amazon links because the booklets are available on Kindle, and I offer some promotions on both Kindle and paperback versions that are only available on Amazon. You may purchase the books through any bookseller by asking for them using the ISBN. You may find all the info you need to order from another bookseller by clicking through to the Amazon link and copying what your bookseller requires from the details below the book.
I do not currently offer the booklets in a language other than English, however I hope to translate into Spanish, French, German, and Italian in the near future as well as add other translations too!
I continue to work on editing the new version of the booklets, so clinics and rescues and shelters may still take advantage of the offer I have had in place for many years. You may easily use this page to order at a discount for clinics, rescues, and shelters:
I also just finished locating the boots and shoes I use to help pets with neurological problems to gain traction and stability (plus for hot pavement, ice, snow, jagged streets and terrain…) on many Amazon platforms around the world, including the USA, so I posted the links here:
I have included a lot of instruction and helpful hints from my 12+ years of working with different boots, shoes, socks, and more to gain traction for pets on this page and even more instructions are in a separate post linked from the page in the link just above this paragraph. I have a lot more items to post about that will help around the home, besides boots, shoes, etc…but this is what I have finished now, and I didn’t want to wait to put this info right in front of you.
Homework Suggestions After Cat FHO, Femoral Head Ostectomy (Removing the Ball off the Femur at the Hip Joint)
First and Foremost –
Pay attention to the discharge instructions your veterinarian has given you. Really try to follow them.
These instructions usually include keeping your cat as subdued, quiet, and inactive as possible for at least two weeks, preferably with only controlled activity for 8-12 weeks.
I highly recommend that you do not allow your cat to play; no cat rugby, no toys to pounce, no “I’m still the bossiest kitty” smack-downs from the surgery kitty to the other kitties, no smack downs from other kitties to the “wounded” kitty, etc…and definitely no jumping onto things for 8-12 weeks.
Escape Artists –
Given the opportunity, it is highly likely your cat will escape from you upon arriving home from the hospital. It will probably immediately occur to your cat to promptly and speedily dash to some hiding place. The best hiding place is one where you cannot reach them. You know.
It is better to keep your cat in their crate, and when you arrive home from the clinic, keep kitty in a place of your choosing to oversee them during this time of healing. I’m pretty sure controlled restriction from the beginning will work out best versus pulling your cat by the armpits or hind feet out from under the bed.
I do recommend that you shut the doors to the bedroom, closet, and bathroom, if your cat does escape. That way when they do come out from under the bed, you will have a better chance of collecting them and getting them back into a crate.
Surgical Cuts and Recovery –
During this surgery, there was cutting of muscle and other body parts that will need care and time to heal.
The muscle that was cut into during the FHO requires a little over six (6) weeks to make a normal collagen ratio and will take even more time to heal fully. You should consider that info when you think your cat is ready to jump onto high places at two (2) weeks after surgery. Don’t let them if you hope for the best results from the surgery.
Use the E-Collar –
A hard e-collar will almost always work the best.
A soft e-collar will not work if the pet can get around it to lick their surgery site.
Scar Tissue –
Just as in recovery from canine FHO, we count on the right amount of the right kind of scar tissue to help stabilize the joint after surgery. This scar tissue only forms correctly under the right circumstances and over a couple of months of doing the right activities.
Too little of the correct activity allows the scar tissue to bind and tighten tissue in the hip area. Too much activity, especially dynamic or rambunctious activity, tears the scar tissue that is forming and causes extra bulky scarring.
Sometimes scar tissue bulking is removed in over-active dogs. I do not personally know of anyone who has paid for a 2nd surgery to de-bulk their cat’s hip scar tissue. I do meet cats with lots of problems moving their leg after FHO due to excessive scar tissue. There are other reasons why they may have trouble moving the operated leg, too.
On the other hand, the bone that was cut, the femur, does not need the same care that a fracture repair would; the head of the femur was cut off completely. There is no bone healing from bone to bone, as there is after a fracture.
You do not need to wrestle with your cat to apply ice to the surgery site; I no longer recommend icingacross the board after most surgeries or injuries. Advanced research findings over the past 10+ years support this. I do recommend using ice if your cat is in pain and therefore probably isn’t getting enough of the right kinds of pain medications. There are many reasons for pain after surgery, and dosing the right medicine(s) for your pet should encourage body use, whatever the problem. I have more info on icing if youclick here.
In physical rehabilitation after FHO we should aim at keeping the “false” joint comfortable after surgery. The false joint is the pocket area of proper scar tissue that forms by slow, repetitive weight-bearing movement. The best way is to promote hip flexion (bending) and extension (stretching out) through natural therapeutic exercises that stimulate leg use, not range of motionexercises. Natural leg use drills lead to muscle strengthening and avoid chronic lack of use of the operated limb.
Range of Motion? NO.
Since the cat will move on their own when they are comfortable and become even more comfortable with the right amount of the right pain medicines and restrictions, I DO NOT recommend pet owners try to dorange of motion (ROM). I have a paper discussing thathere.
I know it is popular for veterinarians to recommend ROM after surgery or injury. Please read the papers I referenced ^^. And thank you 🙂
So What Do I Do?
For comfortable and progressive results after surgery, I recommend working on some of the rehab activities noted below:
Some cats like going on leash walks with their peeps, and if your cat is one of them, then you may follow the standard foundation-building homework I write for canines. You may want to try to carry out that homework even if you have not previously “walked” your cat on a leash, either inside or outside. Please use a harness to introduce this walking activity. If your cat is one of those “paralyzed” cats in a harness, then perhaps regular walking won’t work as soon as I’d like it to. It’s up to you; play around with it, but again, don’t get into a wrestling match with your post-surgical cat.
During the first two weeks especially, we want your cat to walk and stretch and use their operated leg in a natural, yet controlled way and with moderate to slow movements. Any walking is fine, i.e., to the litter box, to food and water, but avoid pouncing, jumping and dashing altogether or as much as possible.
Structured Walks and Movement Drills –
If your cat is using the leg pretty well a day or two after surgery, then I urge you to slowly increase the time of consistent leg use and otherwise start some structured walking at five days after surgery.
If your cat will not go for structured walks with you, as outlined and as described above, then another possibility is to use a favorite treat to coax them to walk slowly across the floor. You could hold up the treat at head height and crawl along with your cat to get them to walk along in a continual gait pattern as best possible, trying to get to the treat. Two to five minutes of this walking a couple of times a day for the first week will be beneficial for the cat and possibly hard on you. Because…crawling on the floor.
You may also use this same treat method while another person holds the cat on a leash and a harness to introduce the concept of leash walking. If you can accomplish the leash walks, the kitty rehab work should be easier on you.
Some cats will follow a string or feather, etc…pulled slowly across the floor, and you may only use this method if your cat will walk sluggishly. Again, slow, progressive, tissue-building exercise…no pouncing now. Many cats will wait for distance between themselves and the item and then pounce on the string or feather, so use your knowledge of your cat to make good choices. No pouncing until after six weeks or more, depending on rate of recovery. Never less time.
The Goal –
The goal is to encourage enough continual, weight-bearing leg use to create a callous of scar tissue within the compartment where the top of the femur bone now rides. This is very much like the callous that forms on your own sit bones as you become accustomed to riding a bicycle or sitting in a horse’s saddle. Get the idea?
I tell people that the tissue we want is very much like what you get when you ride a bike a lot. If you have not ridden in a while and you go out for a longer ride, the bones at your seat will likely feel like they hurt the next day when you sit in a hard chair. People who frequently ride have scar tissue that operates as padding between bone and tissue. After a couple of riding sessions, the appropriate scar tissue forms and it is no longer painful to sit. The same applies to how much your seat hurts after riding a donkey to the bottom of the Grand Canyon for the first time ever. I’ve not done that, but I hear stories…
This is very similar to the type of tissue I want to see your cat form after an FHO; they need a slow build-up of scar tissue to cushion between the cut femur and the muscle, and while scar tissue is forming due to friction from consistent and proper leg use, I don’t want to tear it or otherwise disrupt it with harsh movements. Excessive movement and subsequent tearing could lead to formation of more bulky scar tissue which makes it harder for the leg to move and sometimes causes nerve pain.
Similarly, we don’t want to allow the animal to not use the leg, because scar tissue will form that will bind the leg into a place of reduced function and it will always then hurt to do some favorite activities in the future.
Not too much, not too little.
Too much activity and/or abrupt, jumping movements could tear up the scar tissue we want to form and instead create more “bad” scarring from the new damage. Eventually, with too much activity, there could be a bulk of scar tissue and increased pain from that.
Bulking doesn’t seem to happen as often in cats as it does in dogs, primarily because they may not weigh as much, and therefore do not put as much pressure on the surgery leg when doing the wrong activities. Cats are also in theory easier for people to control after surgery, in contrast to the large Labrador that has an FHO and caretakers that let it run amok.
That extra, harsh, impact pressure is what can cause the top of the cut femur to tear into the healing area where instead we’d like to have a callous of scar tissue form. Slow, steady, easy exercise encourages the best healing in most cases.
Deeper Problems –
After about five (5) days, and especially if your cat is not using the leg much by then, I recommend you speak to your veterinarian about finding some additional pain control medications that will suit your cat.
Recovery will improve if your pet feels less pain and is able to use their leg more “normally”, yet gently. Pain medicine helps achieve this, as do other pain “helps”. In my experience the medications are needed for an average of four (4) weeks for cats after this surgery, if not more.
No, as amusing as it might be, your cat does not need a water treadmill workout to start walking again!
Too Much Femur Remaining –
Another common problem after FHO is that not enough of the femur head was removed during surgery. This could mean that the remaining bone is too tall and continually cutting into surrounding tissue. This could also mean that one piece of the femur is jutting out into the surrounding tissue and cutting it. I have seen this occur many times in dogs.
If I am asked to review a case and I suspect that there is too much femur head remaining, I ask the client to get a post-surgical x-ray from their veterinarian, preferably the veterinarian who did the surgery. This can help confirm the situation I described above. It is standard procedure to take an x-ray after the surgery, so it shouldn’t cost you additional money to get that x-ray for your records.
Not Another Surgery!?
Many times people do not want to put their pet through another surgery. I have helped pets recover from the “too much femur” condition many times. The recovery in these cases (and in the cases I help recover without surgery) occurs by building out the thigh muscles, and that occurs with a lot of the right kinds of exercise drills. You will also need a lot of pain medicine.
Water treadmill work can take the place of pain medicine in some rehabilitation cases, but on the whole, rehab practitioners spend too much time on the same work volume when they rely on the water treadmill. It is also not very practical to work most animals at a clinic in a water treadmill, especially when you have these programs available to use at home and if you have dealt properly with causes of pain.
I frequently take over rehab cases wherein the pet has been working on the treadmill three times per week for months and hasn’t improved past a very basic point. More on water treadmill.
If you are going to “fix” the extra femur piece problem without surgery, you will have to invest in a structured pain control protocol with your veterinarian. You also need exercise drills designed by a strength and conditioning specialist who understands sports medicine rehabilitation. I am definitely available for in-person or phone consults regarding this situation.
Or, get the second surgery.
Timing Medications & Drills –
You should also time medication dosing so that the pain medications are helping with the exercises. I recommend doing the drills or walks or other exercises between 45 minutes after giving the medications and up to 4 hours after dosing. Follow the recovery time I recommend in-between drills. If you have more questions about this, please see this book and these instructions for now.
Extending and Stretching the Surgery Leg –
There are a variety of easy and healing ways to get your cat to stretch out that operated hind leg. Any may be utilized as long as the end result is not further injury. I find that with careful restrictions and exercise, along with proper pain medication, cats will usually come around to using their leg as well as ever, if not better, without anyone stretching it or forcing movement.
If I meet a cat patient more than six weeks after surgery they should be using their leg well. If they aren’t using the surgery leg in extension, I will check to determine if there is crunchiness in the hip area. Crepitus at the hip after FHO often indicates that there is a piece of femur sticking out into the tissue. This is usually causing pain. See discussion about that several paragraphs above this one.
I check for crepitus or issues with the incision area, discussing with the veterinarian if need be, and clear the cat from other medical issues, so far as we are able. I then work on exercises and drills that encourage the cat to stretch their surgery leg on their own.
Continuing Work –
Sometimes I get a cat to extend from the floor to a couch, slowly, for a treat or toy. They leave their back paws on the floor and slowly reach up with the front. Then I draw them back to the floor again. During the first four weeks this method only works best if the cat does not end up jumping onto furniture. A stretching drill like this should be done 2-4 times per day with 10 repetitions each time. Please allow your cat to rest and recover at least two hours between exercise sessions.
After three weeks of base-building exercise then you may begin more structured play. This work should encourage stretching, leg use, and muscle strengthening. You can use a feather in the air that your cat will rise onto their hind legs and bat. Two to three minutes of this type of play or twenty repetitions at this time, twice per day is beneficial.
At four weeks, if your cat will walk with you up and down stairs without bounding, start stair walking. Some cats will follow the owner for continual repetitions. Other cats will need a leash and harness. Some cats will walk away. Do what you can, and keep in mind that several easy repetitions of continuous movement are needed to encourage recovery. Sporadic activity will not build the base your cat needs to flourish.
After Building a Base –
Where and when possible, a set of 5 x 8-10 stairs once every other day could be a good workout. Any slow climbing is better than none, only after building a base first. More repetitions in a row are better for the muscles than only one or two stairs here and there.
By three to four weeks, your cat will be wanting to run around more. They will function as if they are ready for all the “usual” household activities. I recommend you avoid harsh movements during healing. This is so your cat doesn’t tear the good scar tissue that has already formed from following these instructions. Capillaries also need time to heal after any surgery.
If your pet is not using the operated leg after week one, then I recommend calling your vet for recheck and pain medications. You may also contact me for rehab intervention and to get them started on beneficial exercise. Of course you may show this plan to your veterinarian.
If you follow this exercise prescription well and would like advanced exercises, then contact me for a consult. There is a contact form at the bottom of this page <<Click on link . Use this form if you would like to schedule a paid phone or in-person consult with me for rehabilitation for your cat.
My 8 month old goldendoodle had ocd shoulder surgery 10 weeks ago. It was not arthroscopic, but open surgery. He was still limping 4 weeks later, so he was opened up again for a second surgery on the same shoulder. It has been five weeks. He has been given the series of 8 adequan shots, which he just finished, and he limps as bad or worse that he did at the beginning. What can we do? I am heartbroken. My vet says he has ocd in the other shoulder as well, but I’m not about to do anything about it, until we can get our dog out of pain from his first shoulder.
hi! I just finished my last appointment and I’m on my phone right now voice texting you via email. are you near me in Austin, Texas? my first thought is this takes quite a while to heal and your dog needs more pain medication. what meds is your dog on right now? also, since this takes a while to heal, she should be doing specific short controlled walks and no extra activity around the house. let me know what’s going on with these things- Deborah
Sadly, I am not near you. I live in Missouri. We actually have 2 doodles. They are brothers. I think that might be part of the problem, however, the vet said that after 4 weeks of quiet time, that there are no restrictions on Cxxx (my poor puppy). He can run like the wind with his brother, but walking slowly is a real challenge. I could go on forever. Are you in the medical field, or are you familiar with this problem? I feel so bad for him. Yesterday was a beautiful day, so he ran around alot. Today, he walks almost like his leg is broken. I give him 1/2 of a Rimadyl tablet, every few days. I’ve heard so many bad stories about how that drug hurts his liver, so I hate to keep him on it. I also have some tramadol left over from the second surgery, but I didn’t know if it was okay to use it. I really thought the adequan shots were going to be the miracle drug, but I don’t see any change at all. I so appreciate taking the time to discuss this with me, as I am at wits end, and the thought of putting him through another surgery just sounds awful to me. Thanks again for your response. P
Thank you 🙂 (for the kudos on the FB page) So, from what you have said, everything I have posted on my WordPress website should answer your dilemma even though this info is different from what you might have heard to do. Cxxx needs pain relief and at least 12 weeks of no crashing around and very slow exercise protocol. No wild running. Read all my posts on pain after surgery. Yes, I am very familiar, as you may have figured out by now, and I was blessed to have Grace Great Dane in my life for 10.5 yrs, and she had very bad OCD in one knee and mild in the other. That’s a longer story I haven’t written. Anyway, in all my years of athletic involvement and now animal recovery, the biggest issue I have seen is lack of appropriate recovery time. Get a harness and MAKE him go slowly, following any of my post-surgical homework assignments beginning at WEEK 1. Use the Tramadol as if just after surgery, and see if that is enough to enable solid leg use during the very, very slow walks, and if so, you won’t need to use the nsaid for now. If you need to use the anti-inflammatory (nsaid), it is likely not going to do a bunch of damage. Usually vets don’t prescribe the meds without checking blood work anyway, and that was likely checked prior to surgery, at the least. The bone was modified, and at the least the recovery time is 12 weeks. That is a general statement, but you will almost never, ever go wrong with strict control and specific recovery and rest. I am currently working with two Goldendoodle sisters, and yes, they collaborate to damage each other. This is a good opportunity to work on your being the alpha and doing some training. 🙂 Blessings- Deborah
You also said this in the other mail stream: The Rimadyl doesn’t seem to take the edge off either. I give him a baby aspirin sometimes too. He was first diagnosed with pano. I knew something was wrong since he was 5 months old, but I was always told it was “growing pains”. We went to a different vet, who took xrays and found the divit in his bone. The Dr. said it was about the size of his thumbnail. When he went in the second time, he went in the backside and found more, some of the cartilage had taken hold, but some had not. I could explain more, but don’t want to bore you with details. Wish I could bring him in to see you. P
So, more replies for you… Adequan is ok. In theory it is better than ok, however in my experience, very many animals do not respond notably to it. It is expensive for something that often doesn’t bring the expected relief. If you have a pet that doesn’t seem to notably benefit, then it is likely that he is not getting enough benefit to warrant the cost and potential drama of application. My Dane didn’t seem to benefit. Once in a while I see a pet that the owners REALLY think is benefiting from Adequan, so it’s likely a good choice for them.
Do not give baby aspirin along with another anti-inflammatory. It is very important to not double up on any nsaids (anti-inflammatories: Prednisone, Rimadyl, Deramaxx, Previcox, Metacam, Meloxicam, Vetprofen, etc…). They will be quick to give a bleeding stomach ulcer. Like I suggested previously, stick to the dog nsaid and let it do the work is is supposed to, use it as a good tool, and then he will be able to get off it for longer periods in his life. ALWAYS give an nsaid on a full meal, not just with a snack and definitely not an empty stomach. Tramadol may be given on an empty stomach, as may Gabapentin.
If you don’t give more restricted care and medication to the shoulder(s) now, the chance for arthritis increases, and since arthritis is likely at this point, take care and be gentle to let the body heal better.
I highly recommend Omega 3’s in fish oil, either by using sardines as part of daily food (reduce kibble accordingly and don’t make him fat :)), or using a good quality supplement. Find a supplement that contains about 400 mg of EPA in each capsule and start with one of those daily, moving up to 2 daily after about a week and after seeing that he adjusts in his gut (no squishy poop).
I also really like Xymogen DJD as a joint health formula.
I also highly recommend going grain-free in food and treats. Short story is that grains are difficult to digest and they are pro-inflammatory. End of short story. Substantial clinical research validates this.